Provider Demographics
NPI:1902928492
Name:DAVID H. VERZELLA, D.D.S.
Entity Type:Organization
Organization Name:DAVID H. VERZELLA, D.D.S.
Other - Org Name:PRAIRIE DENTAL EXCELLENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-878-6417
Mailing Address - Street 1:4998 W BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1647
Mailing Address - Country:US
Mailing Address - Phone:614-878-6417
Mailing Address - Fax:614-878-0881
Practice Address - Street 1:4998 W BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1647
Practice Address - Country:US
Practice Address - Phone:614-878-6417
Practice Address - Fax:614-878-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31177001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty